A clinical study of acute intestinal obstruction due to mesodiverticular band in children

Abstract

Objective To explore the clinical characteristics, pathogenesis, diagnosis and treatment of acute intestinal obstruction due to mesodiverticular band in children. Methods The clinical data of 17 patients with acute intestinal obstruction due to mesodiverticular band between 1998 and 2018 were retrospectively analyzed along with a review of literatures. Results The male-to-female ratio was 13∶4. One case was 7-month-old stillbirth from an autopsy study. The median age at diagnosis was 4.2 years. The common symptoms were vomiting, abdominal pain and/or distension. None of them had any operative history. And 35.3%(6/17) of them had both mesodiverticular band (MB) and Meckel's diverticulum (MD) and 64.7%(11/17) had MB only. Nine cases received a pathologic diagnosis while the others were clinical diagnosed by intraoperative findings. Except 1 case didn’t rescue because of total colonic aganglionosis after removal of the obstruction, all children through surgery treatment were cured. MB led to strangulation of necrotic bowel (n=5), intestinal perforation (n=1) and intestinal rupture (n=1). Surgical resection of MB and bowel were performed in 7 cases, just MB resection (partially with MD resection) in the remainder. Except for one recent case this year, the remainder were operated without any complication during 1-year follow-up. Conclusions Resulting from the remnant of vitelline vessel, MB frequently leads to acute intestinal obstruction. Lacking specific clinical symptoms and physical examinations, it has a high rate of underdiagnosis and misdiagnosis. Unexplained abdominal pain and distension without an operative history should raise a high alert particularly for strangulated intestinal obstruction. Timely operative intervention is beneficial for preventing intestinal necrosis or even sudden death. The bands causing acute intestinal obstruction should be closely examined and a routine pathological examination is necessary. Key words: Intestinal obstruction; Mesentery; Diverticulum